ED, or erectile dysfunction, is a serious risk to men’s physical and mental health. Your doctor will decide if you have ED based on how well your penis erects during sex. if your penis fails to achieve and maintain a full erection for a satisfying sex life for at least 3 months during sex, then ED may be stalking you and you need to go to the hospital for regular examination and treatment.
You may be concerned about what causes ED. Modern medical research has proven that the causes of ED are many, roughly divided into psychogenic (such as mental stress, life stress, bad sexual experiences) and organic (such as arteriosclerosis, hypertension, heart disease, peripheral vascular disease, neuropathy, diabetes, hyperprolactinemia, endocrine disorders) two categories, in addition to increasing age, lack of sexual knowledge, spousal disharmony, taking drugs that affect erectile function In addition, there are age, lack of sexual knowledge, spousal disharmony, taking drugs that affect erectile function, trauma, surgery and other related factors.
So what should I do if I suffer from ED? Is there no chance to enjoy your sexual life? The answer is no. Modern medicine has invented: basic treatment, oral drug therapy, vacuum negative pressure erection aid device, vascular surgery treatment and penile prosthesis implantation and other treatment methods. The majority of patients are able to regain their virility. Among them, oral medication for ED is one of the preferred, basic and simple and effective treatment modalities. Commonly used oral medications include PDE5 inhibitors, proprietary Chinese medicines, and androgens. The following are introduced separately.
I. PDE5 inhibitors.
Since the launch of PDE5 inhibitors represented by sildenafil in 1998, the treatment of ED has been revolutionized by a breakthrough. Then this drug is mistaken for an aphrodisiac by some people, to expand its efficacy. Others consider it to be an androgenic drug and fear the formation of dependence. Therefore, it is necessary to understand its principle of action. Modern medical research has found that phosphodiesterase inhibitor type V (PDE5) is mainly distributed in the smooth muscle of the penile corpus cavernosum and can specifically degrade the second messenger cGMP synthesized under the induction of NO in the smooth muscle cells of the penile corpus cavernosum, which reduces its concentration and inhibits the relaxation of the smooth muscle of the penile corpus cavernosum and keeps the penis in a weak state. Sexual stimulation induces the release of NO from penile cavernous nerve endings and endothelial cells, which increases the biosynthesis of cGMP.
Oral administration of PDE5 inhibitors inhibits the degradation of cGMP and increases its concentration, which leads to relaxation of cavernous smooth muscle, causing dilatation of penile cavernous arteries, expansion of cavernous sinus and blood filling, and strengthening penile erection. At present, the commonly used PDE5 inhibitors include sildenafil, vardenafil and tadalafil. 3 kinds of PDE5 inhibitors have the same pharmacological mechanism of action, and can enhance erectile function only after sufficient sexual stimulation after oral administration, with an overall efficiency of about 80% for ED patients.
1, sildenafil (sildenafil, trade name: Viagra).
Sildenafil, marketed in 1998, the first PDE5 inhibitor on the market. The dose of sildenafil is 50mg and 100mg respectively. sildenafil is recommended to start with a full dose and adjust the dose according to the efficacy and adverse effects. The efficacy of sildenafil 50mg and 100mg was 77% and 84%, respectively, compared to 25% for placebo; sildenafil improved erectile function in diabetic patients by 66.6% and sexual intercourse success by 63%; compared to 28.6% and 33% for placebo controls, respectively. Sildenafil is effective 30-60 minutes after oral administration, and may affect absorption after a high-fat diet. Diet has little effect on efficacy, and alcohol has no significant effect on its pharmacokinetics.
2, tadalafil (tadalafil, trade name: cialis).
Tadalafil, approved for clinical use in February 2003. The structure of tadalafil is significantly different from that of sildenafil and vardenafil, with a long half-life (17.5 hours). The effective concentration of tadalafil can be maintained for 36 hours. Diet has little effect on its potency and alcohol has no significant effect on pharmacokinetics. Patients taking tadalafil 10 mg and 20 mg had efficacy rates of 67% and 81%, respectively; placebo was 35%.
Statistics showed that tadalafil significantly improved patients’ IIEF (International Index of Erectile Function), SEP2 (Sexual Activity Log 2), SEP3 (Sexual Activity Log 3), GAQ (General Assessment Question) and satisfaction scores. Tadalafil is recommended to start with a full dose and the dose should be adjusted according to efficacy and adverse effects. Tadalafil improved erectile function in 64% of patients with diabetic ED; 25% of the control group. Studies have found that the drug has a rapid onset of action (within 30 min), long-lasting effect, and the freedom to schedule sex for up to 36 hours after taking tadalafil, and is not affected by a high-fat diet after taking the drug, and can drink a small amount of alcohol after taking tadalafil without adverse effects, which is one of its advantages.
3, vardenafil (vardenafil, trade name: Elidel).
Vardenafil, marketed in March 2003. The structure of vardenafil is slightly different from that of sildenafil, and the overall clinical efficacy is similar to that of sildenafil. Fatty meals can affect its absorption, and alcohol has no significant effect on its efficacy. The efficacy of vardenafil 10mg and 20mg was 76% and 80% respectively. Clinical studies have shown that vardenafil significantly improves IIEF, SEP2 and SEP3, GAQ and satisfaction scores; vardenafil is recommended to be started at full dose and the dose should be adjusted according to efficacy and adverse effects.
Vardenafil improved erectile function in 72% of diabetic patients compared to 13% with placebo. It is the fastest-acting PDE5 inhibitor to date, with a rapid onset of action, with patients achieving full erection for sexual intercourse as early as 10 minutes after oral administration. The absolute oral bioavailability of vardenafil is 15%, and it can be absorbed rapidly with a plasma clearance half-life of about 4 to 5 hours.
Second, androgen therapy.
Patients with primary or secondary hypogonadism due to various causes are often combined with ED, androgen therapy for such patients can enhance libido and improve erectile function. In ED patients with low testosterone levels, androgen supplementation can improve erectile function in patients who do not respond to PDE5 inhibitors for the first time, and the combination with PDE5 inhibitors can have a beneficial effect. Androgen supplementation is safe for the treatment of ED patients with low testosterone levels, but it is contraindicated in patients with prostate cancer or suspected prostate cancer.
Therefore, prostate rectal examination (DRE), PSA measurement and liver function tests should be routinely performed prior to androgen supplementation. Patients receiving androgen supplementation therapy should undergo regular tests of liver function and prostate cancer indicators. The effect of androgen therapy to improve erectile function is correlated with serum testosterone levels. For ED patients with normal testosterone levels, testosterone therapy is not recommended due to the lack of evidence-based medical evidence.
Third, proprietary Chinese medicine treatment.
Chinese medicine has a history of several thousand years in the treatment of impotence and is the main medicine for impotence in the Chinese nation. The drug can shorten the erection latency, increase the number of ejaculation, and enhance the libido and ejaculation function while enhancing the patient’s erectile function, and also has a strong psychological comforting effect on the patient. The current market for the treatment of impotence of a wide variety of proprietary Chinese medicine, such as: dredging liver Yi Yang capsule, Jian Yang tablets, Long Lu capsule, compound Xuanju capsule, etc., need to be applied on the basis of Chinese medical diagnosis and treatment, mainly for psychological and mild, moderate organic ED patients.
Therefore, if you are unfortunate enough to suffer from ED, do not panic, please go to a regular hospital for examination and treatment. Depending on your situation doctors may prescribe you a variety of prescription drugs, please follow the doctor’s instructions to take at ease. If it does not work, then go to the hospital to change the second or third line of treatment options. You will definitely be able to revive your virility and enjoy your sexual life.